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Open Access Research article

Impaired skeletal muscle microcirculation in systemic sclerosis

Sasan Partovi1, Anja-Carina Schulte1, Markus Aschwanden2, Daniel Staub2, Daniela Benz3, Stephan Imfeld2, Björn Jacobi1, Pavel Broz2, Kurt A Jäger2, Martin Takes1, Rolf W Huegli1, Deniz Bilecen1 and Ulrich A Walker3*

Author Affiliations

1 Department of Radiology and Nuclear Medicine, University Hospital Bruderholz, Kantonsspital Bruderholz, CH-4101 Bruderholz, Switzerland

2 Department of Angiology, University Hospital Basel, Petersgraben 4, CH 4031 Basel, Switzerland

3 Department of Rheumatology, University Hospital Basel, Felix Platter-Spital, Burgfelderstrasse 101, CH 4012 Basel, Switzerland

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Arthritis Research & Therapy 2012, 14:R209  doi:10.1186/ar4047

Published: 4 October 2012

Abstract

Introduction

Muscle symptoms in systemic sclerosis (SSc) may originate from altered skeletal muscle microcirculation, which can be investigated by means of blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI).

Methods

After ethics committee approval and written consent, 11 consecutive SSc patients (5 men, mean age 52.6 years, mean SSc disease duration 5.4 years) and 12 healthy volunteers (4 men, mean age 45.1 years) were included. Subjects with peripheral arterial occlusive disease were excluded. BOLD MRI was performed on calf muscles during cuff-induced ischemia and reactive hyperemia, using a 3-T whole-body scanner (Verio, Siemens, Erlangen, Germany) and fat-suppressed single-short multi-echo echo planar imaging (EPI) with four different effective echo times. Muscle BOLD signal time courses were obtained for gastrocnemius and soleus muscles: minimal hemoglobin oxygen saturation (T2*min) and maximal T2* values (T2*max), time to T2* peak (TTP), and slopes of oxygen normalization after T2* peaking.

Results

The vast majority of SSc patients lacked skeletal muscle atrophy, weakness or serum creatine kinase elevation. Nevertheless, more intense oxygen desaturation during ischemia was observed in calf muscles of SSc patients (mean T2*min -15.0%), compared with controls (-9.1%, P = 0.02). SSc patients also had impaired oxygenation during hyperemia (median T2*max 9.2% vs. 20.1%, respectively, P = 0.007). The slope of muscle oxygen normalization was significantly less steep and prolonged (TTP) in SSc patients (P<0.001 for both). Similar differences were found at a separate analysis of gastrocnemius and soleus muscles, with most pronounced impairment in the gastrocnemius.

Conclusions

BOLD MRI demonstrates a significant impairment of skeletal muscle microcirculation in SSc.

Keywords:
Systemic sclerosis; skeletal muscle; vasculopathy; magnetic resonance imaging